The Register Citizen (Torrington, CT)
Measured presidential praise
Two of the Senate’s leading Republican moderates, Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, said they needed more time to study the bill
before committing.
President Donald Trump, who embraced the House bill only to deride it later as “mean,” offered guarded praise Thursday for the Senate bill. Getting a bill through Congress will require “a little negotiation, but it’s going to be very good,” he said at the White House. “We will hopefully get something done, and it will be something with heart and very meaningful.”
Like its House counterpart, the Senate bill would eliminate federal funding of Planned Parenthood, and bring the curtain down on most elements of the Affordable Care Act — Obamacare — including the mandate that all must have health insurance, the expansion of Medicaid, and a bevy of taxes imposed to pay for subsidies.
It does, however, maintain allowing children up to age 26 to remain on parents’ health care plans and language barring denial because of pre-existing conditions.
Its formula for premium tax credits is based on income rather than age, which is used in the House bill. It extends the timeline for elimination of Medicaid expansion, through which 207,600 in Connecticut just above the poverty line got health insurance.
But compared to the House bill, it speeds up the financial capping of Medicaid, which overall covers 856,100 low-income enrollees in Connecticut. As it stands now, Medicaid is an open-ended entitlement — meaning that all in the program can get treatment as needed.
‘A slap in the face’
Compared to the House version, the Senate bill provides less emergency funding for opioid addiction and treatment — $2 billion compared to $65 billion.
That could be problematic for Republican senators such as Rob Portman of Ohio or Shelley Moore Capito of West Virginia, whose states have been particularly hard hit by the opioids crisis.
“This is a slap in the face to any senator with the slightest concern about opioid addiction and abuse,” said Sen. Richard Blumenthal, D-Conn.
Whether House or Senate or, most likely, a combination of both, the longpromised “repeal and replace” effort would bring dramatic changes to states like Connecticut that fully embraced Obamacare.
“It’s a betrayal of trust,” Blumenthal said in an interview. “Connecticut not only relied on but trusted federal promises and commitments (under Obamacare), and it was rewarded enormously with real-life consequences. The numbers of people with health insurance expanded enormously, and people are living healthier and better lives in Connecticut because of the ACA.”
According to data gathered by the non-partisan Kaiser Family Foundation, the number of uninsured in Connecticut went down by 152,500 between 2013 and 2015 — the first years of full implementation of Obamacare.
The Congressional Budget Office has yet to release an analysis of the 142page Senate bill’s impact. A comparable report on the House GOP concluded 23 million fewer would be insured over the next decade than if Obamacare had stayed in place.
Blumenthal and Murphy plan to hold what they termed an “emergency field hearing” on the bill at New Haven City Hall at 1:30 p.m. Friday.
Less generous
Professor Abbe Gluck of the Yale Law School said that, because it doesn’t completely overhaul Obamacare, the Senate bill “actually illustrates that the Affordable Care Act is enormously popular.”
However, she said, the bill is “significantly less generous in that it makes it more harsh. … It doesn’t take away the basic pillars of Obamacare — access to health insurance with government help, regardless of wealth. … It just provides less money.”
Gluck is an expert on Congress and health law and has written extensively on Obamacare. She said the Senate bill redistributes wealth from the poor who rely on Medicaid to the wealthy, who get a bigger tax break. She pointed out that Medicaid wasn’t created by Obamacare (it began in 1965) but that Republicans have used the American Health Care Act to cut the program, “which is what some Republicans have wanted to do for a long time.”
“It does endeavor to change the structure of Medicaid, effectively chopping the amount each state will get [which] will cause Medicaid to be far less comprehensive than it is now.” But she said Republicans gave themselves political cover by delaying the cuts until after 2020 and the next presidential election.
Dr. Howard Forman, director of the health care management program in the Yale School of Public Health, said not only will the cuts in Medicaid “result in a significant budgetary strain on a state like Connecticut,” but that by 2025 states will be “disenrolling Medicaid beneficiaries, reducing coverage for Medicaid beneficiaries or cutting education.”
Forman also teaches economics at Yale and was a health policy fellow in the U.S. Senate, working on Medicare legislation.
“Almost certainly, the overall insurance market will be less stable and more expensive overall” because it does not require healthy people to buy insurance, Forman said. The bill also would lower the income threshold at which people will be eligible for subsidies, giving fewer people coverage.
The maximum income eligibility for an individual is about $47,000 under Obamacare and about $97,200 for a family of four, Forman said. “Now it will be down to $42,000 and $85,000.” People above those limits “lose access to any subsidy from the federal government and that’s a big chunk of the population.”